Comprehensive Notes: Abnormal Psychology

Mood Disorders and Suicide

Symptoms of Depression
1. Anhedonia
2. Changes in appetite, sleep, and activity levels
3. Psychomotor retardation – slower
4. Psychomotor agitation – faster
Specific Themes
- Worthlessness
- Guilt
- Hopelessness
- Suicide
Severe Cases
- Delusions – beliefs with no basis on reality
- Hallucinations – seeing, hearing, or feeling things that aren’t real
Major Depressive Disorder – severe bout of depressive symptoms lasting two weeks or more. Requires:
- Experience EITHER a depressed mood or loss of interest in usual activities
- Four other symptoms of depression
- Chronically for at least 2 weeks
If one depressive episode, diagnosis: Major Depressive Disorder, Single Episode
If 2 or more episodes, separated by at least 2 months without symptoms, diagnosis: Major Depressive
Disorder, Recurrent Episode.
Complicated Grief
- Strong yearning for the deceased person
- Preoccupied with the loss
- Persistent guilt of one’s or others’ behavior toward the deceased
- Difficulty accepting of the finality of loss
- Sense of emptiness and meaninglessness of life
- More likely to be functioning poorly 2-3 years after the loss than people with milder grief
reactions and people with MDD symptoms.
Persistent Depressive Disorder
- Used to be called Dysthymic Disorder and Chronic Major Depressive Disorder in the DSM-IV
- Depressed mood for most of the day, for most days than not, for at least 2 yrs
- Children and adolescents, depressed or irritable for at least 1 yr
For children and adolescent diagnosis, two or more of the following symptoms:
- Poor appetite
- Insomnia
 - Fatigue/Low energy
- Low self-esteem
- Poor concentration and/or
- Helplessness
Subtypes of MDD (Specifiers)
1. Anxious distress
- Comorbid anxiety disorders or symptoms
- Presence of anxiety indicates a more severe condition, makes suicidal thoughts and completed
suicide more like, predicts poorer outcome from treatment
2. Mixed features
- Predominantly depressive episodes that have at least 3 mania symptoms
- Applies to both MDD and PDD
3. Melancholic features
- Applies ONLY IF full criteria for major depressive episode have been met
- Include more severe somatic symptoms, early morning awakenings, weight loss, loss of libido,
excessive/inappropriate guilt, and anhedonia
4. Psychotic features
- Hallucinations
- Delusions
- Mood Congruent/Incongruent
- Delusions of Grandeur
5. Catatonic features
- Can be applied to major depressive episodes whether they occur in the context of a PDD or not,
even to manic episodes
- Catalepsy – absence of movement
- May involve excessive but random movements
6. Atypical features
- Applies to both depressive episodes, whether in context of persistent depressive episodes or not
- Consistently oversleep and overeat during depression thus gaining weight
- More symptoms, more severe symptoms, more suicide attempts, higher rate of comorbid
disorders including alcohol abuse
7. Seasonal patters
- Applies to recurrent major depressive and bipolar disorders
- Episodes occur during certain seasons
- Most usual pattern starts in late fall and ends with start of spring
- Occurring for at least 2 yrs with no evidence of non-seasonal major depressive episodes occurring
during that period
8. Peripartum onset
- Period before and just after birth
- Early recognition of possible psychotic depressive or manic episodes is important, few tragic
cases killed their newborn child during an episode

Seasonal Affective Disorder

- Depressive eps begin in late fall and ends with beginning of spring
 - Occurred for at least 2 yrs with no evidence of seasonal major depressive eps occurring during
that period
- 2 yrs of experiencing and fully recovering from major depressive eps
- Mood changes must seem to come on without reason or cause
Premenstrual Dysphoric Disorder
- Significant increases in distress during the premenstrual phase of their menstrual cycle
- Mixture of depression, anxiety and tension, and irritability and anger BEFORE onset of menses
Bipolar Disorder
I- Mania and Depression
II- Hypomania and Depression (shorter depression)
Symptoms of Mania
- Can be elated but it is often mixed with irritation and agitation
- Unrealistically positive and grandiose/inflated self-esteem
- Delusional thoughts
- Agitated and irritable with people who they think are getting in the way
Bipolar I
- 1 manic mood for at least 1 week
- Three other symptoms of mania
- Depression as severe as major depressive eps but could also be mild
- At least 3 key symptoms of depression
Bipolar II
- Severe episodes of depression that meet the criteria for major depression
- Eps for mania are milder a.k.a. hypomania
Mania and Hypomania Differences
- Hypo involves symptoms of mania
- In hypo, symptoms are not severe enough to interfere with daily functioning
- Don’t involve hallucinations or delusions
- Last at least 4 consecutive days
Cyclothymic Disorder
- Alternates between periods of hypomanic symptoms and periods of depressive symptoms
Rapid Cycling Bipolar Disorder
- Four or more mood eps that meet criteria for manic, hypomanic, or major depression within 1 yr
Disruptive Mood Dysregulation Disorder
- Severe temper outbursts grossly out of proportion in intensity and duration to a situation and
inconsistent with developmental level
Theories of Depression
 1. Genetics
2. Neurotransmitter systems
3. Structural and functional abnormalities
4. Neuroendocrine factors
Treatment of Mood Disorders
Medication
1. Selective Serotonin Reuptake Inhibitors (SSRIs) – block the presynaptic reuptake of serotonin;
temporarily increases levels of serotonin at the receptor site
2. Mixed Reuptake Inhibitors – blocks reuptake of norepinephrine as well as serotonin
3. MAO Inhibitors – blocks the enzyme MAO that breaks down such neurotransmitters as
norepinephrine and serotonin
4. Trycyclic Antidepressants – seem to have the greatest effect by down-regulating norepinephrine
through other neurotransmitter systems
5. St, John’s Wort – some prelim evidence suggest the herb somehow alters serotonin function
6. Lithium – antidepressant; often effective in preventing and treating manic episodes a.k.a. mood-
stabilizing drug; gold standard for treating bipolar disorder
Electroconvulsive Therapy and Transcranial Magnetic Stimulation
- Most controversial treatment after psychosurgery
- Patients are anesthesized to reduce discomfort and given muscle-relaxing drugs to prevent bone
breakage from convulsions during seizures
- Electric shocks are administered directly through the brain for less than a second, producing a
seizure and a series of brief convulsions that usually lasts for several minutes
- Every other day for a total of 6 to 10 treatments
Cognitive Behavior Therapy
- Identifying automatic thoughts and challenging them
Interpersonal Psychotherapy
- Highly structured, takes longer than 15 to 20 sessions; include the following interpersonal issues
- dealing within interpersonal role disputes
- adjusting to the loss of a relationship
- acquiring new relationships
- identifying and correcting deficits in social skills
Suicide Indices
1. Suicidal Ideation – thinking seriously about suicide
2. Suicidal Plans – formulation of a specific method for killing oneself
3. Suicidal attempt – person survives
Types of suicide
1. Altruistic
2. Egoistic
3. Anomic
 4. Fatalistic
Eating Disorders
- Those who initially meet criteria for one of these disorders “migrate” between them, meeting
criteria for two or more of the disorders at different times
- Individuals show behaviors and concerns characteristic of one or more of the eating disorders
without meeting the full criteria for these disorders
Anorexia Nervosa
- Starve themselves, little to no food for long periods, yet they remain convinced that they need to
lose more weight
- Body weight is significantly below what is minimally normal for their age and height
- Distorted body image
- Chronically fatigued
- Amenorrhea: when menstrual periods stop
Restricting Type
- Refuse to eat, engage in excessive exercise as a way to prevent weight gain
- Attempt to go on for days with eating
- Small amount of food consumption just to stay alive or pressure from others
Binge-Purge Type
- Periodically engage in binge eating or purging behaviors
- Continues to do so despite being below the healthy body weight
- Doesn’t engage in binges where large amounts of food are eaten
- Person feels the need to purge the food even if its only a small amount and would consider it as
binging
Effects of Anorexia
1. Cardiovascular complications: bradycardia, arrythmia, heart failure
2. Acute expansion of stomach
3. Reduced bone strength
4. Kidney damage
5. Impaired immune system response
6. 31x suicidal rate than general population
Bulimia Nervosa
- Bingeing; uncontrolled eating
- Behaviors designed to prevent weight gain
- 1-3 eps of compensatory behavior in a week (Mild): vomiting, laxative abuse, diuretics, other
purging meds
- Onset often occurs in adolescence
- Occurs over a discrete period of time (1-2 hrs) and involving amounts of food definitely larger
than most people would eat during a similar period of time and in similar circumstances
- Complications: electrolyte imbalance, fluid loss following excessive and chronic vomiting,
laxative and diuretic abuse
 - 7.5x suicide rate than general population
Binge-Eating Disorder
- Resembles bulimia but doesn’t regularly engage in purging, fasting, or excessive exercise to
compensate for binges
- May eat rapidly and appear dazed while eating
- Significantly overweight, say they are disgusted with their body and ashamed for bingeing
- History of frequent dieting, membership in weight control programs, and family obesity
Night Eating Disorder
- Regularly eat excessive amounts of food after dinner and into the night
- Eating behavior isn’t part of cultural or social norms
- Overwhelming desire to eat at night most nights of the week. Highly distressed that they cannot
control their eating behavior
Subtypes
1. Diet subtype
2. Depressive subtype
Psychotherapy for Bulimia Nervosa and Binge Eating Disorder
- Cognitive Behavioral Therapy
- Psychodynamic Therapy
- Interpersonal Therapy
- Behavioral Therapy
Biological Therapies
1. SSRIs – bulimia nervosa
2. Antidepressants – anorexia nervosa
3. Olanzapine
Personality Disorders
- Characteristic ways of thinking and behavior cause significant stress to self or others
- Person can’t change the way of relating to the world and is unhappy
- Person with personality disorder may not feel distress, others may
- Either you have the disorder or you don’t
PD Clusters
Cluster A: Odd or Eccentric – Paranoid, Schizoid, Schizotypal
Cluster B: Dramatic, emotional or erratic – Antisocial, Borderline, Histrionic, Narcissistic
Cluster C: Anxious or Fearful – Avoidant, Dependent, Obsessive-Compulsive
Gender Differences
Equal among men and women: Paranoid, Borderline
Slightly more common among men: Schizoid, Schizotypal, Narcissistic, Obsessive-Compulsive
Slightly more common among women: Histrionic, Avoidant
Much more common among men: Antisocial
Much more common among women: Dependent
Cluster A:
Paranoid Personality Disorder
GET FACT
Grudges held for a long period
Exploitation expected without sufficient basis
Trustworthiness of others doubted
Fidelity of sexual partner questioned
Attacks on character are perceived
Confides in others rarely, if not at all
Threatening meaning read into events
Causes:
1. Slightly more common among relatives of people with schizophrenia, association doesn’t seem
strong
2. Strong role for genetics
3. May be related to early mistreatment or childhood traumatic experiences
4. Maladaptive view of the world
5. Cultural factors prisoners, refugees, hearing-impaired people, older adults
Treatment:
- Unlikely to seek professional help because of general mistrust
- Important to establish a meaningful therapeutic alliance as a first step
- Seek therapy because of a crisis in life or other problems like anxiety or depression
- Provide atmosphere conducive for development of trust
Schizoid Personality Disorder
SIR SAFE
Solitary lifestyle
Indifferent to praise or concen
Relationships of no interest
Sexual experiences not of interest
Activities not enjoyed
Friends lacking
Emotionally cold and detached
Causes:
- Little empirical data on nature and causes
- Childhood shyness precursor to later Schizoid PD
- Personality trait inherited and serves as important determinant in development of disorder
- Abuse and neglect reported
- Parents of children with autism most likely to have Schizoid PD
Treatment:
- Rare for people with this disorder to request treatment in response to a crisis
- Therapists often begin treatment by pointing out value in social relationships
- Take part of a friend or significant other in role-playing to help practice establishing and
maintaining social relationships
- Social skills training helped by identifying social network
- Limited outcome research, caution in evaluating effectiveness of treatment for people with
Schizoid PD
Schizotypal Personality Disorder
UFO AIDER
Unusual perceptions
Friendliness except for family
Odd beliefs, thinking, and speech
Affect – inappropriate, constricted
Ideas of reference
Doubts others
Eccentric – appearance and behavior
Reluctant in social situations, anxious
Causes:
- Schizotype: people who are predisposed to develop schizophrenia
- Phenotype: expressed genetic traits
- Genotype: genes that make up a particular disorder
- Generalized brain abnormalities in people with Schizotypal PD in MRI
Treatment:
- 30-50% who request clinical help also meet criteria for MDD
- Includes some of the medical and psychological treatments for depression
- Combination of approaches: antipsychotic medication, community treatment, and social skill
training
- Prevention strategy to avoid onset of schizophrenia, promising
Cluster B:
Antisocial Personality Disorder
Callous Man
Conduct disorder before 15 yrs old, current age at least 18 yrs old
Antisocial acts, commits acts that are ground for arrest
Lies frequently
Lacunae – lacks a superego
Obligations not honored
Unstable – can’t plan ahead
Safety of self and others ignored
Money problems – spouse and children not supported
Aggressive/Assaultive
Not occurring exclusively during schizophrenia or mania
Defining Criteria:
- 16 major characteristics, sometimes referred to as the Cleckley Criteria
- Cleckly/Hare criteria
- Conduct Disorder
Causes:
- Genetics
- Exposure to harsh environments
Treatments:
- Rarely identify themselves as needing treatment
- Can manipulate even their therapists
- Identifying high-risk children so treatment can be attempted before reaching adulthood
- CBT can reduce likelihood of violence 5 yrs after treatment
- Success rate depends on: high degree of family dysfunction, socio-economic disadvantage, high
family stress, parental history of ASPD, child’s severe conduct disorder
Borderline Personality Disorder
I RAISED A PAIN
Identity disturbance
Relationships are unstable
Abandonment frantically avoided (real or imagined)
Impulsivity
Suicidal gestures (threats, self mutilation, etc)
Emptiness
Dissociative symptoms
Affective instability
Paranoid ideation (stress-related and transient)
Anger is poorly controlled
Idealization followed by devaluation
Negativistic (undermine themselves with self-evaluating behavior)
Causes:
- More prevalent in families with the disorder, somehow linked to mood disorders
- Emotional reactivity
- Elevated tendency to experience shame associated with low self-esteem, quality of life, and high
levels of anger and hostility
- Suffered terrible abuse or neglect from parents
- Sexual abuse, physical abuse, or both
- Rapid cultural changes
- Childhood sexual abuse; not necessary or sufficient to produce symptoms
Treatment:
- Appear distressed and more likely to seek treatment
- Mood stabilizers
- Dialectical Behavior Therapy
Histrionic Personality Disorder
I CRAVE SIN
Inappropriate behavior (seductive to provocative)
Center of attention
Relationships seen as closer than they really are
Appearance is the most important
Vulnerable to others’ suggestions
Emotional expression exaggerated
Shifting emotions, shallow
Impressionistic manner of speaking (lacks detail)
Novelty is craved
Causes:
 - Possible relationship with ASPD
- Histrionic/ASPD – sex typed alternative expressions of the same unidentified underlying
condition
- Further research is need
Treatment:
- Little research to demonstrate treatment success
- Modify attention-getting behavior
- Teaching more appropriate was to negotiate their wants and needs
Narcissistic Personality Disorder
A FAME GAME
Admiration required excessively
Fantasizing unlimited success, brilliance
Arrogant
Manipulative
Envious of other
Grandiose sense of importance
Association with special people
Me first attitude
Empathy lacking
Treatment:
- Limited research
- Therapy focused on their grandiosity, hypersensitivity to evaluation, and lack of empathy to
others
- Cognitive behavioral therapy to replace fantasies
- Coping strategies like relaxation training to help face and accept criticisms
- Help focus on others’ feeling
Cluster C
Avoidant Personality Disorder
RIDICULE
Restrained within relationships
Inhibited in interpersonal situations
Disapproval expected at work
Inadequacy, view of self
Criticism expected in social situations
Unwilling to get involved
Longs for attachment to others
Embarrassment is the feared emotion
Causes:
- Related to subschizophrenia related disorders
- Born with difficult temperaments or personality characteristics, rejected by parents, not provided
with enough early, uncritical love
- Rejection results in low self-esteem and social alienation
Treatment:
- Behavioral intervention techniques for anxiety and social skills problems have had some success
- Similar treatment for social phobia
- Therapeutic alliance appears to be an important predicator for treatment success
Dependent Personality Disorder
DARN HURT
Difficulty expressing disagreement
Advice – needs excessive input
Responsibility for major areas delegated to others
Nurturance – needs excessive degree from others
Helpless when alone
Unrealistically preoccupied with being left to care for self
Relationship desperately sought when one ends
Tasks – has difficulty initiating projects
Cause and Treatments:
- Early death of a parent or neglect or rejection by caregivers could cause people to grow up
fearing abandonment
- Genetic influence
- Little research for treatment
- Submissiveness negates one of the major goals of therapy – to make them independent and
personally responsible
- Therapy progresses gradually as they develop confidence in their ability to make decisions
independently
Obsessive-Compulsive Personality Disorder
LOW MIRTH
Leisure activity is minimal
Organizational focus
Work and productivity predominate
Miserly spending habits
Inflexible around morals, values, etc,
Rigidity and stubbornness
Task completion impaired by perfectionism
Hoards things – can’t discard them
Causes and Treatment:
- Weak genetic contribution
- Predisposed to favor structure in their lives
- Therapy; often attacks fears that seem to underlie the need for orderliness, fear of doing
inadequate work
- Relaxation or distraction techniques to redirect compulsive thoughts (CBT)